Role of Social Determinants of Health in Accessing Gender-Affirming Facial Surgery.

Objectives: This study investigates the role of social determinants of health (SDOH) in accessing gender-affirming facial surgery (GFS) at a single tertiary care institution. By examining the demographic, socioeconomic, and health profiles of patients, this study seeks to characterize barriers in pursuing GFS and identify possible areas for growth in providing equitable care.

Methods: A mixed-methods approach was employed, including a retrospective chart review of all previous GFS patients at a single institution and semi-structured interviews. Data collected in the chart review included demographic, surgical, and socioeconomic characteristics of the patient population. Two researchers performed inductive analysis of the interview transcripts to ensure cross-coder reliability and to identify key themes and subthemes.

Results: A total of 142 patients met the inclusion criteria for chart review. Findings from the chart review indicated that this patient population predominantly identified as White (37.3%), female (92.3%), publicly insured (73.9%), and demonstrated a high prevalence of depression (55.6%), anxiety (43.7%), and PTSD (23.2%). Semi-structured interviews were conducted with 11 patients. Key barriers in pursuing GFS identified in the interviews included insurance coverage concerns, logistical hurdles in scheduling GFS, and social stigma, while protective factors included support from loved ones and trans-friendly healthcare providers.

Conclusion: This study highlights the critical influence that SDOH have on GFS access, particularly emphasizing the need for more supportive healthcare policies, accessible mental health resources, and more comprehensive patient and provider education. Addressing these barriers driven by SDOH can improve GFS access for gender-diverse individuals.

Level of evidence: Level 3.